Vocal fold paralysis

Vocal fold paralysis can make it difficult to speak, breathe and swallow. Ear, nose and throat (ENT) specialists at Atrium Health Floyd and Harbin Clinic are experienced in diagnosing and managing this condition. They work with speech therapists to help you speak more clearly and function better.

What is vocal fold paralysis?

Vocal fold paralysis is a condition that affects the function of your vocal folds (cords). Your vocal cords are two muscular bands of tissue in your voice box (larynx), which is located at the top of your windpipe (trachea). They open when you breathe and close when you swallow. When you use your voice, the cords vibrate to make sound.

In vocal fold paralysis, one or both vocal cords are unable to move. This paralysis can cause problems with speaking, breathing and swallowing. In some cases, vocal fold paralysis can be life-threatening or cause serious health issues.

Causes & types of vocal fold paralysis

Vocal fold paralysis happens when the nerve pathway to the vocal cords is damaged. This pathway includes your brain, vagus nerve and laryngeal nerve, which controls vocal cord movement.

Many conditions of the neck, head and chest can affect these structures. Some examples include:

• Cancer, such as lung, thyroid and laryngeal cancers
• Congenital anomalies present at birth
• Injury from trauma or surgery for another condition
• Neurological diseases, such as stroke, multiple sclerosis and Parkinson’s disease
• Infections, such as Lyme disease and the herpes virus

Sometimes, doctors are unable to find the exact cause of vocal fold paralysis.

Vocal fold paralysis is most commonly unilateral, meaning it affects one vocal cord. In rare cases, it’s bilateral and affects both vocal cords.

Vocal fold paralysis symptoms

Symptoms of vocal fold paralysis range from mild to severe, and may include:

• Hoarse or breathy voice
• Inability to speak loudly or change the pitch of your voice
• Noisy breathing (stridor)
• Shortness of breath or, rarely, inability to breathe
• Trouble swallowing or choking while eating if food enters the windpipe

Vocal fold paralysis diagnosis

You’ll typically see an ENT specialist for diagnosis and treatment. They will:

• Review your symptoms and medical history
• Listen to your voice
• Examine your vocal cords using a thin tube equipped with a camera and light (laryngoscope)

Your doctor may also perform laryngeal electromyography to assess your vocal cords. This test measures electrical activity in the voice box muscles.

Vocal fold paralysis treatment

Voice therapy and surgery are the main treatments for vocal fold paralysis.

Voice therapy

Some people recover their voices within a year of diagnosis, so doctors often hold off on surgery. During this time, your doctor may recommend voice therapy.

In voice therapy, you may learn exercises to strengthen your vocal cords. Your therapist may also show you ways to change how you speak or protect your windpipe when you swallow.

Surgery

Your doctor may recommend surgery if you have ongoing or severe vocal fold paralysis. A common approach is to move the paralyzed vocal cord toward the middle of the windpipe opening by:

• Injecting a bulking agent into the vocal cord
• Placing an implant next to the vocal cord (medialization laryngoplasty)

Another type of surgery involves replacing the damaged laryngeal nerve with another nerve in your neck. Voice therapy is usually recommended after surgery to help you heal and improve your ability to speak and swallow.

If you have bilateral vocal fold paralysis, you may need a tracheotomy to help you breathe. In this procedure, a surgeon places a breathing tube into your windpipe through an opening in the front of your neck. Following a tracheotomy, a speech-language pathologist can help you learn how to speak and care for the breathing tube.